Recently I was talking on Twitter about the “mortality gap”, the fact that people with severe and enduring mental illnesses tend to die 10-20 years earlier than people without. Much justifiable outrage was expressed, but then a friend said something that made me think. She wasn’t sure the gap was that all bad a thing, because she didn’t think she wanted to live to be an older person with bipolar.
I am close friends with someone in her eighties, and it’s made me re-examine the idea of aging and mental health. She has recently had to go into residential care due to increasing physical frailty, but over the past few years she lived around the corner from me in a little garden flat where we would sit and eat biscuits and gossip together.
I would never have met my friend if were not for the perils of older persons’ mental health. Moving to London from the countryside was not her choice. Her husband, who she described as dynamic and highly ambitious, had already had enter a care home due to advancing Alzheimer’s. My friend was no long able to drive to see him, so a move for both of them – the garden flat for her, a new care home for him – somewhere closer to family and with better public transport seemed the most practical option.
My friend often experiences low mood – indeed, part of the reason we bonded so well was that we were both at home alone all day and both frequently sad. I struggle to imagine what it must be like for someone who was a nurse in the Blitz, who raised four children and followed her husband around the country in pursuit of career opportunities, who travelled to exotic and sometimes risky locations, to suddenly live alone in a tiny flat. Care home staff exhorted her to “be strong” for her husband, although he had not been in a position to be strong for her for a long time. I was very sad to hear that my friend’s husband recently died, but it was clear she had been grieving the loss of the man she loved for many years already.
My friend has no more compunction about taking pills than I do. She takes her antidepressants because she thinks they just might help. When she had a fall she was admitted to an excellent rehabilitation unit focusing very much on getting patients back into their own homes as soon as possible. The staff were incredibly warm and caring, yet when my friend’s daughter and I arrived for a visit, my friend was in floods of tears. A quick review of her drugs chart revealed that no one had picked up that she needed antidepressants, so she’d been without them for several days. I couldn’t help picturing myself in 40 years’ time, in a hospital bed or a care home chair, my mental health needs forgotten, overshadowed by the fractured hip, the osteoporosis, the mobility problems.
Mental health in later life is not just about dementia, although goodness knows we need better ways of addressing it, including earlier intervention and greater maximisation of what function dementia sufferers do have. It’s about remembering that older people are just like any other segment of the population: some will have lifelong mental health conditions, while others are at risk of new mental distress due to major life changes such as bereavement, loss of a work role, deteriorating physical health, relinquishment of independence, loneliness. Either way, mental distress needs to be identified and treated, and this means clinicians need to look behind presenting problems and see the person. Because we won’t stop being sad or mad just because we’re old.